While adults may use electronic nicotine delivery systems (ENDS) as reduced harm products to aid quitting smoking, most young adults are nicotine-naive and are using ENDS recreationally. This contributes to the renormalization of smoking behavior in our society and the rebound in its long-term cardiovascular and carcinogenic effects, said Geraldine R. Britton, director of the Binghamton University Interdisciplinary Tobacco Use Research Program.

There is an epidemic of electronic nicotine delivery systems (ENDS), as well as marijuana vaping use among youth and young adults in the United States. Middle, high school and college bathrooms, and lecture halls are filled with sweet-smelling vapors. Terms, such as juuling, have entered the lexicon. What are the unforeseen short and long-term consequences of these products previously marketed as safer than cigarettes and as a smoking cessation method? Although the research is in its infancy, there are some recent data. The CDC has reported that as of August 27, 2019, 25 states are investigating more than 215 possible cases of life threatening pulmonary diseases and several deaths associated with the use of vaping products. Also a review by the National Academy of Sciences in 2018 found that:

1. Although rare, ENDS devices can explode, causing harm to users

2. their vapers release toxins in the atmosphere and

3. the products include varying ingredients and dosing of nicotine (and marijuana), making it difficult to regulate.

Each JUUL pod in the United States contains the nicotine equivalent of a pack of cigarettes, delivering 59 mg/ml, three times the EU limit. Preliminary evidence suggests that since these pods are easily hidden (e.g. devices plugged into computers, even wrist watches), users may have continuous access with no breaks between hits, resulting in extremely high levels of nicotine to the body. The concern with usage among young adults, specifically those under age 25, is that nicotine can harm the parts of the brain that control addictive behaviors, attention, learning, mood, and impulse control.